Asif Sultan

External fixation of pediatric femoral shaft fractures: a consecutive study based on 45 fractures.

Forty-five displaced femur fractures in children were treated with unilateral external fixation as a standard treatment from March 2007 to March 2009 and the last follow-up was completed in May 2012. The average age of the children at presentation was 9.93 years. Patients were followed up till union, at 1 year, and at an average of 3.5 years after fixation. The fixator was removed at an average of 12.23 weeks. Twenty-one (47%) patients had a minor complication of pin-site infection. One patient had a major complication of refracture. Treatment of uncomplicated femur fractures using an external fixator in children yields satisfactory results. Our series had a longer duration of follow-up and fewer refractures compared with other series.

Toilet seat injury of the Achilles tendon a series of twelve cases

Lacerations of the Achilles tendon are caused by a number of mechanisms. The toilet seat as a cause of Achilles tendon injury is rare. We report on this rare mechanism of laceration of the tendo Achilles. The injury can be avoided with the use of western toilets and the additional devascularisation caused by extending the wound should be avoided while repairing the tendon in such situations.

Bilateral simultaneous anterior obturator dislocation of the hip by an unusual mechanism - a case report.

A case of bilateral simultaneous anterior dislocation of the hip in a 30-year-old female is presented herein. The patient was managed conservatively. Follow-up at two years showed excellent results with no signs of avascular necrosis. The cause and mechanism of injury are discussed, which are different from those of previously reported cases.

Deformity Correction about Knee with Ilizarov Technique: Accuracy of Correction and Effectiveness of Gradual Distraction after Conventional Straight Cut Osteotomy.

BACKGROUND The aim of the study was to retrospectively analyse the long term clinical outcome, accuracy of correction, and the complication rate in patients treated for deformities around the knee with gradual distraction with or without additional limb lengthening using Ilizarov technique. MATERIAL AND METHODS The study presents a retrospective analysis of 26 patients treated for deformities about the knee by gradual distraction with Ilizarov technique with an average follow-up of 6.1 yrs (2-13 yrs). Preoperative and post-operative radiographs of all patients were assessed for the deformities. Deformity involved the tibia in 16 patients and the femur in 9 patients and one patient had both components. The deformity comprised of varus in 15 patients and valgus in 11 patients, and deformity in two planes (oblique plane) in 2 patients, while 8 patients had either deformity with associated average shortening of 4.75 cms (2-7 cm).The mean angle of deformity in the frontal plane was 30 degrees (15-60 degrees) and 48 deg on sagital plane. The CORA (centre of rotation of angulation) was located in the juxtaepiphyseal region in 15 patients, metaphysis in 6 patients and at the metadiaphyseal junction in 5 patients. RESULTS All except two adult patients achieved exact correction with gradual distraction at an average correction of 30 degrees. Exact limb lengthening was achieved in all 8 patients with shortening. Complications involved mild procurvatum in three patients, mild mismatch of the mechanical and anatomical axes in two patients with tibial deformities, pin tract infection in two patients and one incidence of pin breakage, however, with no true complications. CONCLUSION Gradual distraction after conventional corticotomy provides excellent results with deformities around the knee with or without additional limb lengthening.

Contracture of the Third Toe as a Delayed Presentation of a Foreign Body in the Foot

Foreign body retention in the foot after a penetrating injury is an unusual occurrence with varied presentation. A degree of suspicion needs to be present in situations where there is an inexplicable swelling, sinus, abscess, or tenderness. The authors present a case with a contracture of the third toe that had been caused by plantar fascial fibrosis secondary to retention of a rubber foreign body in the foot. This case report highlights the fact that an ultrasound to rule out retention of the foreign body might be a judicious investigation if common causes of toe contracture are excluded. It may also have therapeutic implications. Level of Evidence: Therapeutic, Level IV

Delayed manifestations of the “Nail-Slipper injury”

Penetrating injuries of the foot are a common presenting complaint in the emergency department. The residents of the underdeveloped world are especially prone to suffer such injuries as barefoot walking is still common. However, a relatively common injury that occurs in the shod feet is the “Nail-Slipper injury”. A metal nail penetrates through the rubber sole of the footwear introducing the rubber piece into the soft tissue of the foot. As the nail is removed the piece remains behind often leading to delayed manifestations. This article describes the various delayed manifestations of this injury. A leading question for the antecedent injury of this kind should be asked from all patients with such presentations, especially in the urban setting.

A reciprocating ledge technique in closing wedge osteotomy for genu valgum in adolescents.

Purpose. To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy. Methods. Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee. Results. All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12–15) weeks. The mean correction of the tibiofemoral angle was 13°. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity. Conclusion. Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.

Management of capitellar fractures with open reduction and internal fixation using Herbert screws

BACKGROUND Capitellar fractures are rare elbow injuries and can cause severe limitation of function if not properly managed. Numerous treatments have evolved, from closed reduction and cast immobilization to open reduction and internal fixation (ORIF), so as to achieve a stable joint that allows early mobilization. We determined the functional outcomes of treating these fractures with ORIF using Herbert screws via an extensile lateral approach. METHODS Fifteen patients with capitellar fractures were included in this retrospective study. A well taken lateral radiograph was important and stressed upon in all patients. All fractures were open reduced and internally fixed using Herbert screws via an extensile lateral approach over a period of 5 years. Clinical, radiographic, and Mayo Elbow Performance Index were evaluated at a mean followup of 3.6 years (range, 1.5-6 years). RESULTS Nine type I and six type IV capitellar fractures were identified using Bryan and Morrey classification system. The average time to bone union was 12 weeks (range 8-16 weeks) with no case of nonunion. The mean range of flexion was 130° (range 125°-135°). The average extensor lag was 10° (range 0°-30°), with a functional range of motion of elbow achieved in all patients. On the final follow-up, one case of osteoarthritis was seen, but no evidence of avascular necrosis or heterotrophic ossification was seen. Two patients needed screw removal. The outcome was excellent in 10 patients and good in five patients. CONCLUSION Herbert screw fixation provides stable fixation in capitellar fractures and good to excellent outcomes with excellent elbow motion, can be achieved following internal fixation of these complex fractures using the extended lateral exposure.